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Oral D, Erdal GG, Tekeş S, Yücel I, Em S. Prevalence of HLA B27 in Patients Diagnosed with Ankylosing Spondylitis (AS) in Diyarbakır, Southeastern Region of Turkey. Niger J Clin Pract 2024; 27:29-34. [PMID: 38317032 DOI: 10.4103/njcp.njcp_258_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/23/2023] [Indexed: 02/07/2024]
Abstract
AIM The research to be conducted on human leukocyte antigen (HLA)-B27 in patients diagnosed with ankylosing spondylitis (AS) in Diyarbakır between 2019-2021 is to contribute to the understanding of the prevalence and effect of this genetic marker in the local population. As a researcher working on HLA-B27 and AS, our focus is to research the following. HLA-B27 Prevalence: To determine the prevalence of HLA-B27 in patients diagnosed with AS during the specified period in Diyarbakır. This information can provide insight into the genetic factors associated with the disease in the local population. Disease Severity: Investigate the relationship between HLA-B27 positivity and severity of AS symptoms. To examine factors such as disease progression, pain levels, functional impairment, and quality of life in HLA-B27 positive patients compared to HLA-B27 negative patients. By Genetic Associations: To enable the discovery of potential genetic relationships between HLA-B27 and other genetic markers known to be associated with AS. To investigate whether there are any specific genetic variants associated with HLA-B27 that contribute to disease susceptibility or severity. Researchers: We recommend considering the following approaches to generate knowledge on this topic globally: Literature Review: Conducting a comprehensive review of the available scientific literature on HLA-B27 and AS. It is to describe relevant studies conducted globally and summarize their findings to provide a broader understanding of the subject. Collaboration and Data Sharing: To encourage cooperation with researchers from other regions or countries doing similar studies on HLA-B27 and ASs. By sharing our data and collaborating on analysis, we can improve the global perspective and generalizability of your findings. International Conferences and Journals: Presenting our research findings at international conferences focusing on rheumatology, genetics or related fields. To disseminate our findings globally is to submit your research articles to reputable journals specializing in AS or genetic studies. Online Platforms: Using online platforms such as Researchgate.net, academia.edu or social media networks to share our research findings, connect with other researchers in the field and participate in discussions on a global scale. By using these fields, it is possible to contribute to the global knowledge and understanding of the relationship between HLA-B27 and AS. It is also to obtain insights from studies carried out in other regions. MATERIALS AND METHODS 198 (104 male and 94 female) patients who applied to Dicle University Faculty of Medicine Physical Therapy and Rehabilitation Clinic with AS symptoms between 2019-2021 and were referred to Dicle University Medical Biology and Genetics Department for evaluation. HLA-B27 positivity was included in our study as a case group. As the control group, 50 people (25 males, 25 females) were selected among the unrelated people who applied to our laboratory to be a bone marrow donor. In both groups, DNA isolation was performed from peripheral blood using the salt precipitation method. Rotar Gene Q device was used for real-time PCR analysis. As a statistical method in analysis; The prevalences of the variables of interest were calculated. The lower and upper limits of 95% were determined as the confidence interval. According to the presence of HLA 27 positivity, the mean of ESR, CRP, and age variables were compared. Mann-Whitney U test was used due to the small number of subjects. Also, correlations between ESR and CRP were calculated. Spearman rho correlation statistics were used as a statistical method. Analyzed. RESULT Radiological examinations and laboratory tests were performed on 198 patients with suspicion AS and 50 healthy control group of 248 subjects. The prevalence of those with a definite diagnosis of AS was calculated as statistical analysis recalculated 20.16 (95% CI: 0.76-0.9552). The prevalence of HLA-B27 in 50 patients diagnosed with AS as a result of radiological examinations and laboratory tests was calculated as 92%. CONCLUSION Our study is the first study covering the province of Diyarbakır in the Southeastern Anatolia Region, which we think will contribute to the literature in the evaluation of HLA-B27 positivity in AS patients. The prevalence of HLA-B27 in our region is higher than the prevalence in Turkey.
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Affiliation(s)
- D Oral
- Department of Medical Biology and Genetics, Dicle University, Diyarbakır, Turkey
| | - G G Erdal
- Department of Medical Biology and Genetics, Dicle University, Diyarbakır, Turkey
| | - S Tekeş
- Department of Medical Biology and Genetics, Dicle University, Diyarbakır, Turkey
| | - I Yücel
- Department of Medical Biology and Genetics, Dicle University, Diyarbakır, Turkey
| | - S Em
- Department of Physical Therapy and Rehabilitation, Dicle University, Diyarbakır, Turkey
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Michelena X, López-Medina C, Erra A, Juanola X, Font-Ugalde P, Collantes E, Marzo-Ortega H. Characterising the axial phenotype of psoriatic arthritis: a study comparing axial psoriatic arthritis and ankylosing spondylitis with psoriasis from the REGISPONSER registry. RMD Open 2022; 8:rmdopen-2022-002513. [PMID: 36597989 PMCID: PMC9723956 DOI: 10.1136/rmdopen-2022-002513] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022] Open
Abstract
AIMS To explore the clinical and radiographical characteristics of axial psoriatic arthritis (PsA) and to compare it with ankylosing spondylitis (AS) with psoriasis. METHODS Cross-sectional study from the national multicentre registry REGISPONSER where participants fulfilled the European Spondyloarthropathy Study Group spondyloarthritis criteria at entry. Clinical, laboratory and radiographical characteristics between patients classified as axial PsA and AS with psoriasis by their rheumatologist are compared according to HLA-B27 status. RESULTS Of 2367 patients on REGISPONSER, n=405 had PsA, of whom 27% (n=109) had axial involvement as per the treating rheumatologist. 30% (n=26/86) of axial PsA were HLA-B27 positive. In the AS group, 9% (127/1422) had a history of psoriasis and were more frequently male, with longer diagnostic delay and more anterior uveitis than those with axial PsA who had more peripheral involvement and nail disease. Patients with HLA-B27-negative axial PsA reported less inflammatory pain and structural damage compared with AS with psoriasis. By contrast, HLA-B27-positive axial PsA shared clinical characteristics similar to AS and psoriasis although with a lower BASRI score. In the multivariable analysis, patients with AS and psoriasis were independently associated with HLA-B27 positivity (OR 3.34, 95% CI 1.42 to 7.85) and lumbar structural damage scored by BASRI (OR 2.14, 95% CI 1.4 to 3.19). CONCLUSION The more prevalent axial PsA phenotype is predominantly HLA-B27 negative and presents different clinical and radiological manifestations when compared with AS with psoriasis. There is great heterogeneity in what rheumatologists consider axial PsA from a clinical and imaging perspective, highlighting the need for research into possible genetic drivers and a consensus definition.
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Affiliation(s)
- Xabier Michelena
- Rheumatology, Hospital Universitari Vall d'Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,NIHR Leeds BRC, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Clementina López-Medina
- Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain,Rheumatology, Reina Sofía University Hospital, Córdoba, Spain
| | - Alba Erra
- Rheumatology, Hospital Universitari Vall d'Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Xavier Juanola
- Rheumatology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Pilar Font-Ugalde
- Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain,Rheumatology, Reina Sofía University Hospital, Córdoba, Spain
| | - Eduardo Collantes
- Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain,Rheumatology, Reina Sofía University Hospital, Córdoba, Spain
| | - Helena Marzo-Ortega
- NIHR Leeds BRC, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Schwartzman M, Ermann J, Kuhn KA, Schwartzman S, Weisman MH. Spondyloarthritis in inflammatory bowel disease cohorts: systematic literature review and critical appraisal of study designs. RMD Open 2022; 8:rmdopen-2021-001777. [PMID: 35046098 PMCID: PMC8772455 DOI: 10.1136/rmdopen-2021-001777] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/02/2021] [Indexed: 12/13/2022] Open
Abstract
To critically appraise study designs evaluating spondyloarthritis (SpA) phenotypes in patients with inflammatory bowel disease (IBD). A systematic literature review of PubMed, Ovid, Scopus, Cinahl, Medline, Web of Science, and Cochrane databases was performed. Articles published from January 2000 - March 2020 were included if they evaluated the prevalence/incidence of musculoskeletal disease in cohorts of IBD patients. Most of the 69 included studies were clinic based (54/69, 78%), single center (47/69, 68%) and cross-sectional (60/69, 87%). The median prevalence of axial and peripheral SpA in IBD was 5% (range 1 - 46%) and 16% (range 1 - 43%), respectively. In 38 studies that evaluated axial disease in prospectively enrolled patients, inflammatory back pain was analyzed in 53%. SpA classification criteria were used in 68% and imaging was performed in 76%. In 35 studies that evaluated peripheral disease in prospectively enrolled patients, SpA classification criteria were used in 46%. A physical exam was performed in 74%, and it was performed by a rheumatologist in 54% of studies with a physical exam. Sub-phenotypes of peripheral SpA (mono- or oligo-arthritis, polyarthritis, enthesitis, dactylitis) were variably reported. Seventy-four percent of studies did not mention whether osteoarthritis and fibromyalgia had been assessed or excluded. The spectrum of SpA phenotypes in IBD patients remains incompletely characterized. Future studies should focus on standardizing the variables collected in IBD-SpA cohorts and defining musculoskeletal phenotypes in IBD-SpA in order to better characterize this disease entity and advance the field for clinical and research purposes.
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Affiliation(s)
- Monica Schwartzman
- Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Joerg Ermann
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kristine A Kuhn
- Department of Medicine, Division of Rheumatology, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sergio Schwartzman
- Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Michael H Weisman
- Department of Rheumatology and Immunology, Stanford University School of Medicine, Palo Alto, California, USA
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Kentar Y, Schwarze M, Pepke W, Schiltenwolf M, Akbar M. Pediatric back pain-Diagnostic algorithm. DER ORTHOPADE 2021; 51:36-43. [PMID: 34767043 DOI: 10.1007/s00132-021-04189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Back pain in the pediatric population is common. History and a thorough physical examination and a systematic work-up approach are key components to guide the physician in evaluating the possible causes of pain and providing appropriate treatment. OBJECTIVE The main aim of this review was to develop an algorithmic approach to assist physicians in the assessment of pediatric back pain. A comprehensive review of prevalence, differential diagnoses and proper management of pediatric back pain are also presented. MATERIAL AND METHODS An extensive literature search was performed in PubMed to gather articles on the prevalence, risk factors, diagnostic tools, differential diagnoses and appropriate management of pediatric back pain. RESULTS Available literature revealed that pediatric back pain is a common complaint. Although most cases are non-specific and self-limiting, there is a wide differential that should be considered including inflammatory, neoplastic, infectious and mechanical causes. Sedentary lifestyle, obesity and vigorous physical activity have been shown to increase the likelihood of developing back pain. We proposed an algorithm to guide the physician's decision about the next step in the diagnostic process. CONCLUSION A well-defined strategy in the diagnostic process is needed in approaching children/adolescents with back pain. This would have the benefit of minimizing costs, unnecessary tests and child/family anxiety as well as increasing the likelihood of early diagnosis and proper treatment.
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Affiliation(s)
- Y Kentar
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - M Schwarze
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - W Pepke
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - M Schiltenwolf
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - M Akbar
- MEOCLINIC GmbH, Friedrichstraße 71, 10117, Berlin, Germany.
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Boussaid S, Rahmouni S, Rekik S, Jammali S, Cheour E, Sahli H, Elleuch M. Acute transverse myelitis revealing ankylosing spondylitis: A case report and literature review. Clin Case Rep 2021; 9:e04878. [PMID: 34631068 PMCID: PMC8489386 DOI: 10.1002/ccr3.4878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/16/2021] [Accepted: 09/12/2021] [Indexed: 12/04/2022] Open
Abstract
When faced with a patient with acute myelopathy, thorough investigations should be undertaken to determine the cause. Ankylosing spondylitis should be kept in mind as a possible cause.
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Affiliation(s)
- Soumaya Boussaid
- Rheumatology Department Rabta Hospital Tunis Tunisia
- Faculty of Medicine of Tunis University Tunis el Manar Tunis Tunisia
| | - Safa Rahmouni
- Rheumatology Department Rabta Hospital Tunis Tunisia
- Faculty of Medicine of Tunis University Tunis el Manar Tunis Tunisia
| | - Sonia Rekik
- Rheumatology Department Rabta Hospital Tunis Tunisia
- Faculty of Medicine of Tunis University Tunis el Manar Tunis Tunisia
| | - Samia Jammali
- Rheumatology Department Rabta Hospital Tunis Tunisia
- Faculty of Medicine of Tunis University Tunis el Manar Tunis Tunisia
| | - Elhem Cheour
- Faculty of Medicine of Tunis University Tunis el Manar Tunis Tunisia
- Pain Treatment Center la Rabta hospital Tunis Tunisia
| | - Hela Sahli
- Rheumatology Department Rabta Hospital Tunis Tunisia
- Faculty of Medicine of Tunis University Tunis el Manar Tunis Tunisia
| | - Mohamed Elleuch
- Rheumatology Department Rabta Hospital Tunis Tunisia
- Faculty of Medicine of Tunis University Tunis el Manar Tunis Tunisia
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Ashrafi M, Kuhn KA, Weisman MH. The arthritis connection to inflammatory bowel disease (IBD): why has it taken so long to understand it? RMD Open 2021; 7:e001558. [PMID: 33863841 PMCID: PMC8055104 DOI: 10.1136/rmdopen-2020-001558] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/14/2022] Open
Abstract
Inflammatory bowel disease (IBD) associated arthritis is a subgroup of spondyloarthritis (SpA) that has suffered from lack of recognition in rheumatology clinical and research circles for over 100 years. Although clinically distinguishable from rheumatoid arthritis and ankylosing spondylitis, it took advances in detection systems in the middle of the last century (rheumatoid factor, HLA-B27) to convincingly make the final separations. We now know that significant numbers of patients with SpA have associated clinical IBD and almost half of them show subclinical gut inflammation, yet the connection between the gut and the musculoskeletal system has remained a vexing problem. Two publications from Nathan Zvaifler (one in 1960, the other in 1975) presciently described the relationship between the gut and the spine/peripheral joints heralding much of the work present today in laboratories around the world trying to examine basic mechanisms for the connections (there are likely to be many) between the gut, the environment (presumably our intestinal flora) and the downstream effect on the musculoskeletal system. The role of dysregulated microbiome along with microbiome-driven T helper 17 cell expansion and immune cell migration to the joints has been recognised, all of which occur in the appropriate context of genetic background inside and outside of the human leucocyte antigen system. Moreover, different adhesion molecules that mediate immune cells homing to the gut and joints have been noted. In this review, we studied the origins and evolution of IBD-arthritis, proposed pathogenic mechanisms and the current gaps that need to be filled for a complete understanding of IBD-arthritis.
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Affiliation(s)
- Maedeh Ashrafi
- Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Kristine A Kuhn
- Internal Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael H Weisman
- Internal Medicine, Stanford University School of Medicine, Stanford, California, USA
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Ziade N, Abi Karam G, Merheb G, Mallak I, Irani L, Alam E, Messaykeh J, Menassa J, Mroue' K, Uthman I, Masri AF, Ghorra P, Witte T, Baraliakos X. HLA-B27 prevalence in axial spondyloarthritis patients and in blood donors in a Lebanese population: Results from a nationwide study. Int J Rheum Dis 2019; 22:708-714. [PMID: 30729696 DOI: 10.1111/1756-185x.13487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 12/31/2018] [Accepted: 01/03/2019] [Indexed: 12/31/2022]
Abstract
AIM To calculate the prevalence of human leukocyte antigen (HLA)-B27 in axial spondyloarthritis patients (axSpA) compared to blood donors (BD) in Lebanon, to identify the clinical and radiological findings associated with HLA-B27 and to estimate the proportion of patients fulfilling the clinical arm of the Assessment of the Spondyloarthritis International Association (ASAS) criteria. METHOD Consecutive Lebanese adult axSpA patients fulfilling the ASAS classification criteria were included from 12 rheumatology clinics across Lebanon. BD served as controls. A binary logistic regression was used to study the association between HLA-B27 and the disease features. RESULTS A total of 247 individuals were included (141 axSpA patients and 106 BD). The prevalence of HLA-B27 was 3.8% in BD and 41.1% in axSpA. Overall, 39.7% of the axSpA patients fulfilled the clinical arm of the ASAS classification criteria. Sensitivity of HLA-B27 for axSpA was 41.1%, specificity was 96.2%, positive predictive value was 93.6%, and negative predictive value was 55.13%. Positive likelihood ratio (LR) was 10.9 and negative LR was 1.63. We found a positive association of HLA-B27 with family history of SpA and psoriasis. CONCLUSION Our study confirmed a low prevalence of HLA-B27 in axSpA patients and BD in this Lebanese population, However, we found a high specificity and positive LR, as well as the same number of axSpA patients fulfilling the clinical arm of the ASAS criteria as in European studies. HLA-B27 is therefore valuable for identification of axSpA in Lebanese patients despite the overall low prevalence in this population. Our results may guide future evaluations the role of HLA-B27 in planning local referral strategies.
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Affiliation(s)
- Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.,Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Ghada Abi Karam
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.,Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Georges Merheb
- Rheumatology Department, Holy Spirit University, Kaslik, Lebanon.,Rheumatology Department, Notre-Dame des Secours University, Lebanon
| | - Iyad Mallak
- Radiology Department, Hotel-Dieu de France, Beirut, Lebanon
| | - Laure Irani
- Lebanese University Hospital, Beirut, Lebanon.,Rizk University Medical Center, Beirut, Lebanon
| | - Elie Alam
- Levant Hospital, Sin-el-Fil, Lebanon
| | | | - Jeanine Menassa
- Lebanese University Hospital, Beirut, Lebanon.,Geitawi Hospital, Beirut, Lebanon
| | | | - Imad Uthman
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Pierre Ghorra
- Blood Transfusion Center, Hotel-Dieu de France, Beirut, Lebanon
| | | | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr-Universität Bochum, Bochum, Germany
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Quraishi MK, Badsha H, Khan B, Shahzeb M, Hegde S, Mofti A, Ooi KK. Interethnic Variations and Clinical Features of Spondyloarthropathies in a Middle Eastern Country. Open Rheumatol J 2018; 12:10-18. [PMID: 29456775 PMCID: PMC5806196 DOI: 10.2174/1874312901812010010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/12/2017] [Accepted: 01/12/2018] [Indexed: 01/15/2023] Open
Abstract
Objectives The study aimed to demonstrate the interethnic differences and clinical features of Spondyloarthropathy(SpA) patients in a diverse Middle Eastern Country. Methods A retrospective review of medical records to collect the required data was conducted for SpA patients at two study institutions in the United Arab Emirates. Results Of 141 SpA patients found, 88 AS(Ankylosing Spondylitis) patients and 53 'other SpA' patients were identified. Males constituted 81% of AS and 55% of 'other SpA' patients. Patients with AS and 'other SpA' had a mean age of symptom onset of 28 and 34 years, respectively.49% and 40% of AS and 'other SpA' patients had a history of Anti-TNF therapy usage. Enthesitis and Uveitis were noted in 16% and 18% of AS patients whilst 53% and 11% in 'other SpA' patients, respectively.Caucasian, Indian Subcontinent and Arabs constituted 93% of our cohort. Mean age of onset of symptoms in the Indian Subcontinent 'other SpA' group was much greater than the other two ethnicities. Duration of symptoms to diagnosis was 3.5 and 4 years in AS and other SpA patients' respectively. HLA-B27 positivity was found in 53%, 80% and 93% of Arab, Indian Subcontinent and Caucasian AS patients, respectively, whilst seen in 50%, 25% and 33% of the same respective ethnicties in 'other SpA' patients. Conclusion This study on 141 patients is the largest to analyse inter-ethnic variations in SpA patients in the region. Our cohort shows a short delay in diagnosis with a relatively higher Anti-TNF usage.
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Affiliation(s)
| | - Humeira Badsha
- Department of Rheumatology. Dr. Humeira Badsha Medical Center, Dubai, UAE
| | - Bhavna Khan
- Department of Rheumatology, Dubai Mall Medical Center, Dubai, UAE
| | - Muhammad Shahzeb
- Department of Medicine, Jinnah Medical College Hospital, Karachi, Pakistan
| | - Srilakshmi Hegde
- Department of Rheumatology, Al Biraa Arthritis & Bone Center, Dubai, UAE
| | - Ayman Mofti
- Department of Rheumatology, Al Biraa Arthritis & Bone Center, Dubai, UAE
| | - Kong Kok Ooi
- Department of Rheumatology, Tan Tock Seng Hospital, Singapore
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9
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Yesmin S, Abdal SJ, Rahman A, Islam MN, Ahammad AM, Ahmed S, Shahin MA, Chowdhury MR, Haq SA. Inflammatory back pain and associated disease conditions among patients with chronic low back pain in Bangladesh. Int J Rheum Dis 2018; 21:937-942. [PMID: 29349901 DOI: 10.1111/1756-185x.13263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Inflammatory back pain (IBP) is the earliest symptom of axial and other forms of spondyloarthritis (SpA). However, there are no published data on prevalence of IBP among patients suffering from chronic low back pain (CLBP) in Bangladesh. In this study, we estimated the prevalence of IBP and the subtypes of SpA in a tertiary hospital in Bangladesh. METHODS This 1 year cross-sectional study was conducted among 240 CLBP patients in a rheumatology outpatient clinic. Assessment of Spondyloarthritis International Society classification criteria of IBP and predefined recognized classification criteria were followed to define different subtypes of SpA. Means and standard deviations were reported for continuous variables. Descriptive and bi-variate analyses were accordingly performed. RESULTS Of 240 CLBP patients, 60 (25%) had IBP and 180 (75%) had mechanical back pain (MBP). Among the 60 IBP patients, 52 (86.6%) had predominantly axial SpA (axSpA) and eight (13.4%) had predominantly peripheral spondyloarthritis. In the axSpA group, 49 (94.2%) had radiographic axSpA (rd-axSpA) also known as AS and three (5.8%) had non-radiographic axSpA (nr-axspA). AxSpA patients could be divided into eight (15.35%) with psoriasis, two (3.8%) with reactive arthritis and one patient (1.9%) had arthritis associated with inflammatory bowel disease. Fifty (83.3%) IBP and 73 (40.6%) MBP patients had age at onset of back pain < 40 years. Forty-two (70%) of the IBP and 100 (55.6%) of the MBP patients had normal body mass index. All these differences were statistically significant (P ≤ 0.0001). CONCLUSIONS Inflammatory back pain is common among patients presenting with CLBP. The commonest cause of IBP is AS, followed by PsA and nr-axSpA.
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Affiliation(s)
| | - Syed Jamil Abdal
- Green Life Center for Rheumatic Care & Research, Dhaka, Bangladesh
| | - Aminur Rahman
- International Center for Diarrheal Disease Research, Bangladesh
| | - Md Nazrul Islam
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Shamim Ahmed
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Abu Shahin
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Syed Atiqul Haq
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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10
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Ganapathy PS, Lowder CY, Srivastava SK. Aggressive Initial Presentation of HLA-B27 Uveitis in Older Individuals: A Case Series. Ocul Immunol Inflamm 2016; 26:425-427. [PMID: 27726461 DOI: 10.1080/09273948.2016.1234626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE HLA-B27-associated uveitis is classically thought to be a disease of the young, with a median age of onset in the 30s. There is a paucity of literature reporting on older individuals with HLA-B27 uveitis. Here, we describe cases of HLA-B27 uveitis presenting initially at age ≥70. METHODS Retrospective review of patients with HLA-B27-associated uveitis that presented initially at ≥70 years of age. RESULTS Three patients were identified. All presented with aggressive inflammation (hypopyon in two cases) and two were treated for suspected endophthalmitis. All cases were controlled sufficiently with prolonged topical anti-inflammatory therapy. One patient who was lost to follow-up demonstrated one recurrence over a 3-year period. CONCLUSIONS This series highlights the aggressive initial presentation of HLA-B27-associated uveitis in the older population, and demonstrates the favorable response, and limitation of recurrences, with topical immunosuppressive therapy.
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Affiliation(s)
| | - Careen Y Lowder
- a Cole Eye Institute, Cleveland Clinic , Cleveland , Ohio , USA
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11
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Autoimmune Conditions in 235 Hemochromatosis Probands with HFE C282Y Homozygosity and Their First-Degree Relatives. J Immunol Res 2015; 2015:453046. [PMID: 26504855 PMCID: PMC4609477 DOI: 10.1155/2015/453046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/02/2015] [Indexed: 12/17/2022] Open
Abstract
We performed a retrospective study of autoimmune conditions (ACs) in 235 hemochromatosis probands at diagnosis by analyzing age, sex, ACs, history of first-degree family members with ACs (FH), diabetes, heavy ethanol consumption, elevated serum ALT/AST, nonalcoholic fatty liver disease, viral hepatitis, cirrhosis, iron removed to achieve iron depletion (QFe), and positivity for human leukocyte antigen (HLA) haplotypes A∗01, B∗08; A∗02, B∗44; A∗03, B∗07; A∗03, B∗14; and A∗29, B∗44. There were 138 men (58.7%). Median followup was 19.6 y. One or more of 19 ACs were diagnosed in each of 35 probands (14.9%). Prevalences of Hashimoto's thyroiditis, rheumatoid arthritis, and ankylosing spondylitis were 8.1% (95% CI: [5.1, 12.5]), 1.7% [0.6, 4.6], and 0.0085 [0.0015, 0.0337], respectively. Eighteen probands (7.7%) had a FH. Eight probands with ACs had 9 family members with ACs. In a logistic regression, ACs were less likely in men (odds ratio (OR) 0.3 [0.1, 0.6]) and more likely in probands with a FH (OR 4.1 [1.4, 11.8]). Overall ACs risk was not significantly associated with QFe or HLA haplotypes. Estimated survival of probands with and without ACs did not differ significantly. We conclude that ACs are common in hemochromatosis probands, especially women and probands with a FH.
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Kumar S, Mahajan BB, Ahluwalia RS, Boparai AS. Reiter's disease: Circinate balanitis as alone preceding presentation - Successfully treated with pimecrolimus 1% cream. Indian J Sex Transm Dis AIDS 2015; 36:70-3. [PMID: 26392659 DOI: 10.4103/0253-7184.156733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Circinate balanitis, although a common manifestation of reactive arthritis, is usually an associated finding present along with the triad of arthritis, conjunctivitis, and urethritis. It is rarely seen as the only preceding manifestation of reactive arthritis. We hereby report a case of circinate balanitis as alone preceding presentation of reactive arthritis that was successfully treated with topical pimecrolimus 1% cream.
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Affiliation(s)
- Sumir Kumar
- Department of Dermatology, GGS Medical College, Faridkot, Punjab, India
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Lin C, MacKenzie JD, Courtier JL, Gu JT, Milojevic D. Magnetic resonance imaging findings in juvenile spondyloarthropathy and effects of treatment observed on subsequent imaging. Pediatr Rheumatol Online J 2014; 12:25. [PMID: 25067925 PMCID: PMC4110533 DOI: 10.1186/1546-0096-12-25] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/29/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is often used to diagnose and monitor treatment effects of juvenile spondyloarthropathy (SpA). Our objective was to describe MRI findings in juvenile SpA and determine predictors of active sacroiliitis and response to treatment. METHODS Children who had MRI of the sacroiliac (SI) joints and were referred to the pediatric rheumatology clinic from 2009 to 2012 were retrospectively studied. The clinical parameters, laboratory studies and findings on MRI were collected and a composite score ratio (CR) was calculated for both SI joints on each MRI study based on a semi-quantitative scale that included evaluation of bone marrow edema (BME), synovial enhancement (SE), and erosions (ER). The findings on MRI were correlated with clinical and laboratory values. RESULTS 50 subjects who underwent 76 MRI for suspected or known SpA were included in the study. Sacroiliitis was seen in 48 MRIs in 32 subjects. Of the subjects with sacroiliitis, mean age ± standard deviation was 13.7 ± 2.6 years, 71% were male and 41% were HLA B27 positive. SE without BME was seen in 31% cases of sacroiliitis. In subjects with sacroiliitis, 79% also had hip arthritis and 41% had enthesitis of the pelvic region on MRI. In 38% of subjects with sacroiliitis, physical exam was not indicative of sacroiliitis or hip arthritis. Longitudinal data were available for 13 subjects. Sacroiliitis on MRI improved in 9 subjects with the greatest improvement in MRI composite score ratio after initiation of etanercept therapy. CR improvement was due to improvement of BME and SE components, while the ER score remained the same or worsened in all but 1 subject. CONCLUSION History, physical exam or laboratory data may not predict sacroiliitis in children. Magnetic resonance imaging plays a valuable role in the initial evaluation and later treatment monitoring of children with spondyloarthropathy. Synovial enhancement is significantly reduced after treatment, and unlike adults, synovial enhancement may be detected without accompanying bone marrow edema, which suggests gadolinium contrast may be an important component in the assessment of children with spondyloarthropathy.
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Affiliation(s)
- Clara Lin
- Children’s Hospital Colorado Pediatric Rheumatology, 13123 East 16th Street, Box B311, 80045 Aurora, CO, USA
| | - John D MacKenzie
- UCSF Pediatric Radiology, 505 Parnassus Ave, Moffitt Room: M396, Box 0628, 94143 San Francisco, CA, USA
| | - Jesse L Courtier
- UCSF Pediatric Radiology, 505 Parnassus Ave, Moffitt Room: M396, Box 0628, 94143 San Francisco, CA, USA
| | - Jeffrey T Gu
- UCSF Pediatric Radiology, 505 Parnassus Ave, Moffitt Room: M396, Box 0628, 94143 San Francisco, CA, USA
| | - Diana Milojevic
- Floating Hospital for Children @ Tufts Medical Center, 800 Washington Street #190, 02111 Boston, MA, USA
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Sieper J, Braun J, Kay J, Badalamenti S, Radin AR, Jiao L, Fiore S, Momtahen T, Yancopoulos GD, Stahl N, Inman RD. Sarilumab for the treatment of ankylosing spondylitis: results of a Phase II, randomised, double-blind, placebo-controlled study (ALIGN). Ann Rheum Dis 2014; 74:1051-7. [PMID: 24550171 PMCID: PMC4431338 DOI: 10.1136/annrheumdis-2013-204963] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/24/2014] [Indexed: 11/22/2022]
Abstract
Objectives The ALIGN study (NCT01061723) evaluated the efficacy and safety of sarilumab, the first fully human monoclonal antibody against interleukin-6 receptor-α (IL-6Rα), in patients with ankylosing spondylitis (AS). Methods Patients with active AS despite conventional treatment were randomised to placebo, or one of five subcutaneous dose regimens of sarilumab (100, 150 or 200 mg every other week, or 100 or 150 mg every week), for 12 weeks. The primary efficacy end point was the percentage of patients achieving the Axial SpondyloArthritis international Society (ASAS) 20 response criteria at week 12. Secondary endpoints included ASAS40 response, ASAS partial remission, AS Disease Activity Score, high-sensitivity C-reactive protein (hs-CRP) value, and safety. Results Baseline demographic and disease characteristics of the 301 patients enrolled were similar across treatment groups. At week 12, there was no statistically significant difference in ASAS20 response rate between placebo (ASAS20 = 24.0%) and any sarilumab dose group. A significantly greater reduction in hs-CRP value was achieved with the higher sarilumab doses versus placebo. No other statistically significant differences were evident for secondary efficacy endpoints. The most common treatment-emergent adverse events reported for sarilumab included infections (non-serious), neutropenia, and increase in alanine aminotransferase. No cases of tuberculosis, opportunistic, or fungal infections, or bowel perforations were reported. Seven patients experienced a treatment-emergent serious adverse event (all in sarilumab treatment groups). No deaths occurred. Conclusions The ALIGN study shows that IL-6Rα blockade with sarilumab was not an effective treatment for AS. Sarilumab was generally well tolerated with a manageable safety profile.
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Affiliation(s)
- Joachim Sieper
- Med. Department 1, Rheumatology, Charité University Medicine Berlin, Berlin, Germany
| | | | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Allen R Radin
- Translational Medicine, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Lixia Jiao
- Research and Development, Sanofi, Bridgewater, New Jersey, USA
| | - Stefano Fiore
- Research and Development, Sanofi, Bridgewater, New Jersey, USA
| | - Tanya Momtahen
- Research and Development, Sanofi, Bridgewater, New Jersey, USA
| | - George D Yancopoulos
- Translational Medicine, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Neil Stahl
- Translational Medicine, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Robert D Inman
- Division of Rheumatology, Toronto Hospital Western Division, Toronto, Canada
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15
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Short peptide sequence identity between human viruses and HLA-B27-binding human 'self' peptides. Theory Biosci 2013; 133:79-89. [PMID: 24362932 DOI: 10.1007/s12064-013-0196-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
Abstract
Molecular mimicry and arthritogenic peptides form the basis of hypotheses that attempt to explain the pathogenesis of HLA-B27-positive ankylosing spondylitis (AS). We propose, therefore, that certain human viruses may possess peptide sequences that mimic HLA-B27-binding human 'self' peptides which might induce or play a significant role in AS. In the present study, we performed bioinformatic analysis, using BLASTP, of the human virus proteome and HLA-B27-binding human 'self' peptides including peptides derived from arthritogenic sequences. We identified that some HLA-B27-binding peptides, particularly those present in proteins of the cartilage and bone, are highly similar to those present in viruses known to cause chronic infection. We suggest that the identical short amino acid sequences shared between human viruses and HLA-B27 peptides may play a role in the pathogenesis of AS.
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Bawazeer AM, Joharjy HI. The association of human leukocyte antigen B27 with anterior uveitis in patients from the western region of Saudi Arabia: a retrospective study. Clin Ophthalmol 2013; 7:2107-11. [PMID: 24204112 PMCID: PMC3817032 DOI: 10.2147/opth.s53518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The association of human leukocyte antigen B27 (HLA-B27) with anterior uveitis is well known. The prevalence of HLA-B27 and its relation to anterior uveitis is related to race and geographic location. The association is strongest in Western countries and weakest in Eastern countries. Data regarding this association from Middle Eastern countries are limited. Thus, we undertook the study reported here to evaluate the association of HLA-B27 with anterior uveitis in patients in a tertiary center in the western region of the Saudi Arabia. Methods The study involved a retrospective analysis of the records of patients with anterior uveitis, referred to the uveitis clinic in Magrabi Eye and Ear Hospital, Jeddah, Saudi Arabia, from 1999 to 2010. The cost-effectiveness of HLA-B27 testing was analyzed. Results Among the 587 cases of uveitis, 335 (57.1%; mean age 37.56±12.82 years; 203 male and 132 female) cases were of anterior uveitis. All patients with anterior uveitis were investigated for HLA-B27 positivity. Idiopathic anterior uveitis was the most common (80%), followed by Fuchs heterochromic cyclitis (7.45%) and ankylosing spondylitis (3.8%). Only two patients were HLA-B27 positive. The cost-effectiveness of HLA-B27 testing was found to be 165,000 Saudi riyals (44,594 US dollars) per positive case. Conclusion HLA-B27-related uveitis appears to be very rare in our part of the world. Idiopathic uveitis is the most common type of anterior uveitis. The cost-effectiveness of HLA-B27 testing is low for patients with anterior uveitis in the western region of Saudi Arabia.
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Affiliation(s)
- Ahmed M Bawazeer
- Uveitis Services, Department of Ophthalmology, King Abdulaziz University, Jeddah, Saudi Arabia ; Magrabi Eye and Ear Hospital, Jeddah, Saudi Arabia
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Affiliation(s)
- Clara Lin
- University of California San Francisco, Pediatric Rheumatology, 533 Parnassus Avenue, Box 0107, San Francisco, CA 94113, USA
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Prevalence of HLA-B27 in Patients with Ankylosing Spondylitis in Qatar. Int J Rheumatol 2012; 2012:860213. [PMID: 22548073 PMCID: PMC3324887 DOI: 10.1155/2012/860213] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 01/14/2012] [Accepted: 01/23/2012] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives. The human leukocyte antigen HLA-B27 is a class 1 antigen of the major histocompatibility complex and is strongly associated with ankylosing spondylitis (AS). The purpose of the present study is to investigate the distribution of HLA-B27 in patients with AS of different ethnic groups in Qatar. Design and Setting. Study design was cross-sectional and the setting was rheumatology clinics of Hamad General Hospital in Qatar where most of
ankylosing spondylitis patients are followed up. Patients and Methods. Patients with diagnosis of AS who met the New York modified criteria for AS were tested for HLA-B27. 119 patients were tested for HLA-B27: 66 Arabs, 52 Asians (Indians, Pakistanis, Bengalis, and Iranians), and one Western (Irish). Results. Of all the individuals, 82 were positive (69%) for HLA-B27. Among the Arabs, 49/66 were positive (74%). Among the Asians, 32/52 were positive (61%). Furthermore, Qatari patients (10 males and one female) 9 were positive (82%), 14/19 Jordanians/Palestinians were positive, and 9/10 (90%) Egyptians were positive. Among the Asians, 19/26 Indians were positive (73%), which was similar to the Arabs. Conclusion. HLA-B27 in our small group of Arabs is present in 74%. Comparison with other data will be presented in detail.
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Stanevicha V, Eglite J, Zavadska D, Sochnevs A, Lazareva A, Guseinova D, Shantere R, Gardovska D. HLA B27 allele types in homogeneous groups of juvenile idiopathic arthritis patients in Latvia. Pediatr Rheumatol Online J 2010; 8:26. [PMID: 20946671 PMCID: PMC2964715 DOI: 10.1186/1546-0096-8-26] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 10/14/2010] [Indexed: 01/04/2023] Open
Abstract
UNLABELLED Juvenile idiopathic arthritis (JIA) is a heterogeneous condition and therapeutic strategies vary in different JIA types. The routinely accepted practice to start with Sulphasalazine (SS) as the first line treatment in patients with HLA B27 positive JIA proves to be ineffective in a large proportion of children. OBJECTIVE to investigate HLA B27 positive JIA patients clinical characteristics, determined HLA B27 allele types and their connection with antirheumatic treatment in homogenous patient groups. MATERIALS AND METHODS 56 patients diagnosed with JIA and observed over the period 2006 to 2009 included in the study. HLAB27 allele types were determined using PCR method. RESULTS In HLA B27 positive JIA patients mean disease onset was 12.34 ± 3.3 years. Most common (44%) JIA type was enthesitis related arthritis. Positive response to the treatment with SS was found in 32% of patients, Methotrexate (MTX) - in 43%, combined treatment - SS with MTX was effective in 12.5%. 12.5% of patients required combination MTX with Enbrel.Eight HLA B27 allele types were found in JIA patients in Latvia: *2702, *2703, *2704, *2705, *2710, *2715, *2717, *2728. The most common was *2705 - in 55% of cases. Among all the patients enthesitis related arthritis most commonly occurred in patients with HLAB*2705 allele (OR = 2.01, p < 0.02), oligoarthritis in patients with *2710 allele (OR = 3.0, p < 0.04) and polyarthritis with *2717 allele (OR = 3.0, p < 0.05). In patients with *2705 allele effective treatment was MTX (OR = 1.13, p < 0.03) and MTX with SS (OR = 2.02, p < 0.05), but in patients having *2703 allele - MTX with Enbrel (OR = 2.94, p < 0.02). CONCLUSIONS There are 8 different HLA B27 alleles in JIA patients in Latvia and the most common is *2705, but in order to assert them to be disease associated alleles, more extensive studies are needed, including control group of HLA B27 positive healthy individuals. Standard treatment approach with SS proves to be unsatisfactory in the majority of JIA patients. To improve children's quality of life achieving rapid disease control, the first line treatment in HLA B27 positive patients should be MTX. In order to start with the most appropriate drug it is necessary to determine HLAB 27 type at the onset of disease.
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Affiliation(s)
- Valda Stanevicha
- Department of Pediatrics, Riga Stradins University, Latvia Vienības gatve 45, Rīga, LV 1004, Latvia.
| | - Jelena Eglite
- Laboratory of clinical immunology and immunogenetics, Riga Stradins University, Latvia Biķernieku iela 29- 30, Rīga, LV 1039, Latvia
| | - Dace Zavadska
- Department of Pediatrics, Riga Stradins University, Latvia Vienības gatve 45, Rīga, LV 1004, Latvia
| | - Arturs Sochnevs
- Laboratory of clinical immunology and immunogenetics, Riga Stradins University, Latvia Kr.Valdemāra iela 111- 3, Rīga, LV 1010, Latvia
| | - Arina Lazareva
- Department of Pediatrics, Riga Stradins University, Latvia Adrese: Aviācijas iela 5- 46, Rīga, LV 5- 46, Latvia
| | - Dinara Guseinova
- Children University hospital, Department of Rheumatology Vienības gatve 45, Rīga, LV 1004, Latvia
| | - Ruta Shantere
- Children University hospital, Department of Rheumatology Vienības gatve 45, Rīga, LV 1004, Latvia
| | - Dace Gardovska
- Department of Pediatrics, Riga Stradins University, Latvia Vienības gatve 45, Rīga, LV 1004, Latvia
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Higashi SI, Nakamura T, Tomoda K, Tsukano M, Sakaguchi M, Kuga F. A study of ten Japanese patients with seronegative spondylarthropathy: a tentative proposal. Mod Rheumatol 2007; 15:329-35. [PMID: 17029088 DOI: 10.1007/s10165-005-0414-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Accepted: 06/14/2005] [Indexed: 11/27/2022]
Abstract
We reviewed ten patients with seronegative spondylarthropathy (SNSA), who all fulfilled the European Spondylarthropathy Study Group criteria for spondylarthropathy (SpA); seven patients also met the Amor criteria for SpA. Seronegative spondylarthropathy was not a uniform syndrome but rather a wide spectrum of complex disease with characteristics of sacroiliitis and enthesopathy. The most frequent symptom at diagnosis of SNSA was inflammatory low back pain, followed by asymmetric oligoarthralgia and Achilles tendonitis and/or plantar fasciitis. Systemic complications were revealed as eye and skin involvement. Imaging methods including pelvic radiography, scintigraphy, and computed tomography scanning were useful in detecting spondylarthropathic changes, which were characteristic of SNSA. Human leukocyte antigen (HLA) typing showed various patterns among patients, in which HLA-B27 was positive in three patients with ankylosing spondylitis. HLA-B51, which is a well-known genetic factor associated with Behçet's disease (BD), was positive in two patients who were apparently distinct from BD. Two patients with palmoplantar pustulosis showed symptoms and signs characteristic of SNSA. Although we have few SNSA patients in the present study, we would like to propose that HLA-B51 positive SpA would be considered as a subset of SNSA, and that pustulotic SpA also would be classified as a member of SNSA. This led us to suggest the possibility to change the concept of SNSA proposed by Moll et al. The optimal treatment remains to be defined, but sulfasalazine was effectively used with almost all patients in combination with nonsteroidal anti-inflammatory drugs.
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Affiliation(s)
- Syu-Ichi Higashi
- Section of Internal Medicine and Rheumatology, Kumamoto Center for Arthritis and Rheumatology, 1-15-7 Kuhonji, Kumamoto, 862-0976, Japan
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Campylobacter infection and Guillain–Barré syndrome: public health concerns from a microbial food safety perspective. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.cair.2005.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Mirowski GW. Callen JP. The spectrum of Reiter's disease. J Am Acad Dermatol 1979;1:75-7. J Am Acad Dermatol 2005; 52:1044. [PMID: 15931733 DOI: 10.1016/j.jaad.2005.04.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Colmegna I, Cuchacovich R, Espinoza LR. HLA-B27-associated reactive arthritis: pathogenetic and clinical considerations. Clin Microbiol Rev 2004; 17:348-69. [PMID: 15084505 PMCID: PMC387405 DOI: 10.1128/cmr.17.2.348-369.2004] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Current evidence supports the concept that reactive arthritis (ReA) is an immune-mediated synovitis resulting from slow bacterial infections and showing intra-articular persistence of viable, non-culturable bacteria and/or immunogenetic bacterial antigens synthesized by metabolically active bacteria residing in the joint and/or elsewhere in the body. The mechanisms that lead to the development of ReA are complex and basically involve an interaction between an arthritogenic agent and a predisposed host. The way in which a host accommodates to invasive facultative intracellular bacteria is the key to the development of ReA. The details of the molecular pathways that explain the articular and extra-articular manifestations of the disease are still under investigation. Several studies have been done to gain a better understanding of the pathogenesis of ReA; these constitute the basis for a more rational therapeutic approach to this disease.
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Affiliation(s)
- Inés Colmegna
- Section of Rheumatology, Department of Medicine, LSU Health Science Center, New Orleans, Louisiana 70112, USA
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Abstract
With the mapping of the human genome having been completed, our ability to investigate and ideally better understand the genetic basis of rheumatic diseases is advancing at a rapid pace. Substantial evidence strongly favors a direct role for HLA-B27 in genetic susceptibility to ankylosing spondylitis and related spondyloarthropathies, although the underlying molecular basis has yet to be identified. HLA-B27 contributes only 16 to 50% of the total genetic risk for the disease, clearly indicating that other genes must be involved. However, no other putative disease genes have yet been absolutely proven. Potential genes include MHC (HLA class II, low molecular weight proteasome [LMP], transporter associated with antigen processing (TAP), tumor necrosis factor [TNF]-alpha, and major histocompatibility complex class I chain-related gene A (MICA), as well as non-MHC genes (IL-1RA, IL-6, IL-10, and CYP2D6). Genome-wide screens have identified other chromosomal areas of interest: 1p, 2q, 6p, 9q, 10q, 16q, and 19q. However, different studies have given conflicting results. HLA-B27 itself is a serologic specificity, which encompasses 25 different alleles that encode 23 different products (proteins): HLA-B*2701 to B*2723. These alleles may have evolved from the most widespread subtype, B*2705, and two of them, B*2706 in Southeast Asia and B*2709 in Sardinia, seem not to be associated with ankylosing spondylitis. The distinction between the disease associated and nonassociated subtypes may provide clues to the actual role of B27 in disease pathogenesis.
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Affiliation(s)
- J D Reveille
- Department of Medicine, Division of Rheumatology and Clinical Immunogenetics, The University of Texas-Houston Health Science Center, Houston, Texas, USA
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